Acute ischemic stroke is a leading cause of morbidity and mortality in the United States, and a majority of acute ischemic stroke patients are evaluated for the first time by a clinician in the emergency department.
Given the time-dependent nature of the treatments that have been proven to improve outcomes significantly in patients presenting with AIS, it is important for emergency clinicians to be able to evaluate these patients rapidly for appropriate treatment.
Our recent issue Acute Ischemic Stroke: Emergency Department Management After the 3-Hour Window presents evidence-based guidelines for the diagnosis and treatment of acute ischemic stroke in patients who present more than 3 hours after last known well time.
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Here are a few key points:
- A key element of the history is to obtain the patient’s last known well time, which must be differentiated from the first time that symptoms were noted by witnesses. Often, collateral history will need to be obtained from family or friends.
- Severe hypoglycemia or hyperglycemia can mimic the symptoms of an acute stroke. Point-of-care glucose is a rapid test that is widely available in the ED. Glucose levels should be assessed in every patient presenting with an acute stroke, and corrected, if necessary.
- In patients with a history of a hematologic disorder on anticoagulation, or with a suspicion for a coagulopathy, basic coagulopathy tests including platelet count, INR, and aPTT should be obtained prior to administration of IV tPA.
Last Updated on December 13, 2021